Swab, IgG, Confusing diagnosis

[B-moreFriend]

Hello there and thank you for providing this service.

About me. I’m a woman in my late 40’s. As a kid/teenager I had cold sores which I always understood to be HSV1. As an adult I’ve never had a full outbreak, but I’ve had prodrones (sp) just the tingling and a slightly raised bump on the lip, but they never opened and always receded within the day. Those happened maybe once every 5-10 years. I’ve had 3 previous boyfriends (over a span of 20 years or so) who were positive for hsv2. I had never had any symptoms of hsv2 that I know of. I’ve had lots of other boyfriends and lovers as well. I haven’t had any contact with anyone since March 3rd 2014. I get Std screenings regularly and have never tested positive for anything, but unfortunately don’t have printed results from previous years. I don’t believe I’ve ever been blood tested for HSV as I’ve never had symptoms. And I didn’t bother for H1 since I knew I had it.

In early January 2015 I had been feeling a bit under the weather. I got a sore toward the back of the roof of my mouth (irregular shape, about a centimeter in diameter, yellowish/grey coating.) that was very painful and wasn’t healing so after 4 days I went to a clinic and the Dr said it looked like classic Herpes but she would do a swab test to be sure and prescribed me Valacyclovir. The culture came back “negative” or IgM 1/2 Combination with a result of *1.06. Which falls in the Equivocal range.

A week later the sore had healed fine and I had finished my RX anyway but a new small bump (about a milimeter wide and raised) appeared on the roof of my mouth in the same spot. I went back to the clinic and got a LabCorp type specific blood test. The results came back HSV 1 IgG 0.91 and HSV 2 IgG *4.57. That Dr. advised me that I have had HSV2 for a long time AND that I had the antibodies showing a recent outbreak. He figured my intra oral sore was Hsv2. I figured I got it a long time ago from performing oral sex on one of my H2 positive boyfriends (something we did a lot. I mean a lot a lot.) back then we thought as long as there was no outbreak we were ok. I know now that is not the case.

I started on a 10 day course of 1gram 2/day Valacyclovir. Throughout the 10 days I would get a tiny bump, it would open then heal. And they were not painful. This happened 3 or 4 times. After doing a lot of reading and research I went back to the clinic, talked to a different Dr. who when looking at the swab results AND the IgG results is convinced that I have been positive for HSV2 for a long time and that the sore in my mouth is Not actually Herpes.
I am confused as to why my H1 test came back with a negative number even though I *know* I have HSV1.

What are the chances that the sore in my mouth is H2?
How could I suddenly get an OB that has the hallmarks of a new infection without any contact?
I had been scuba-diving in November and December and wonder if the scuba gear I rented could have exposed me to something. ??
Could it be some other virus and not Herpes?
Does it sound like it’s most likely Herpes?

I’ve gone from thinking I have one of the rare cases of H2 in the mouth to thinking “oh, I have asymptomatic H2 and some weird sore in my mouth.”

Could it be Hsv1?

How do I go about ordering a Western Blot test? The clinic I went to made it sound like it would be next to impossible to send blood across the country (I’m in Maryland.)

Why is the Western Blot more accurate/definitive than the IgG type specific tests?

If I do have Hsv2 orally how easily can I give it to someone by kissing or performing oral sex? What if it’s Hsv1?

Thank you in advance!

• This topic was modified 8 years ago by B-moreFriend.

[Terri Warren]

What are the chances that the sore in my mouth is H2?
I really doubt that it is, but it could be. The only way to know for certain is a swab test, and you said that yours was negative so it seems unlikely that this is HSV 2.

How could I suddenly get an OB that has the hallmarks of a new infection without any contact?

You aren’t having an outbreak with the hallmarks of a new infection. If this in your mouth is HSV 2, is it not behaving like a new infection and you don’t have a new infection because you haven’t had a recent contact and your IgG indicates that you have been infected for quite a while, as both doctors mentioned. The IgM is useless and should be ignored..

I had been scuba-diving in November and December and wonder if the scuba gear I rented could have exposed me to something. ??
I seriously doubt that.

Could it be some other virus and not Herpes?
Are you asking if the sore in your mouth is caused by some other virus and not herpes? That’s certainly possible or it could just be a canker sore and we don’t know what causes them.

Does it sound like it’s most likely Herpes?
You mean the sores in your mouth? Not really, to me.

It could be HSV 1 yes, but then the swab test would have been positive and it wasn’t.

Our clinic can order a western blot for you at a Quest lab in your area. I don’t think that Maryland is one of the states that doesn’t allow shipping out of state but our office would know for certain.

The western blot looks for all the proteins associated with the herpes antibody where the ELISA looks only for one protein.

If you have HSV 2 it is shed infrequently from the mouth, far less frequently than HSV 1. We don’t have statistics on how frequently HSV 1 is transmitted through kissing or oral sex.

Please feel free to ask more questions.

Terri

[B-moreFriend]

Hi Terri, and thank you for answering my questions!

Here’s why I thought it was acting like a new infection: I arrived home from diving on Dec 28th. I spent the next week feeling tired, achy, headachcy, swollen glands, feverish, and just yucky. (In my first post I just said under the weather) and then the sore hit the roof of my mouth. Also I didn’t take pictures of the sore but I found a source that very clearly differentiated between canker sores and Herpes sores. I have posted a photo from that site that looks like my sore looked.
I understand intra-oral herpes sores are usually on the hard, bone-attached areas like the roof of the mouth and the gum line, whereas canker sores are round and usually on the soft moveable parts of the mouth like inside of cheek, lip, and soft palate.

Do you agree with the above description? (regarding the appearance of canker vs. herpes sores inside the mouth)

After the first sore healed I would get a tiny blister/bump (didn’t hurt, and I was on val-acyclovir) that would appear, swell, then pop open, then proceed to heal. That happened 3 times while I was on Val-acyclovir. And I thought that’s what Herpes blisters do in many cases.

You said The IgM is useless and should be ignored. But you also said It could be HSV 1 yes, but then the swab test would have been positive and it wasn’t.
I thought the Swab test IS the IgM test. Is it?
And I’m not sure what Equivocal means as my results were 1.06 which is higher than a negative score but lower than a positive score.

What does an Equivocal score mean?

Should I just not pay attention to the swab IgM test at all? or should I take those results as being negative?
(I ask because the first doc said it was negative but the second doc that did the blood test said that the IgM test indicates a recent outbreak in addition to the IgG test saying I’ve had H2 for a long time.)

Is 4.57 a common score for people who have had HsV2 for along time?

How can the IgG test come back negative for HsV1 when I know I’ve had H1 since childhood?

I also read in some of your other q and a’s on this forum that you have seen a false positive IgG as high as 4.5
Does that happen often?

I plan to get re-tested in about a month as I am finally getting a primary care doc.

Thank you again for taking the time to answer, and thank for all the good work you and your clinic do!
cheers!

[B-moreFriend]

Hi Nurse Terri,

So I’ve sorted out that the swab culture is a different test from the IgM.

I was reading my medical records wrong and now understand that the IgM was one of the blood tests taken. sorry.

I read that if the swab sample is taken from the sore more than 48 hours after the sore appears then there is a higher chance for a false negative. My sample was taken 4-5 days after the sore appeared. In your experience has that been common? the false negative from a sore more than a couple of days old?

Thank you!

[Terri Warren]

The IgG antibody test for HSV 1 is not all that sensitive – it misses 1-2 out of 10 infections. I have very often heard from people “how can my HSV 1 antibody test be negative – I’ve had cold sores all my life”. That’s why. The western blot for hereps is far more sensitive for HSV 1. It is also the test that would be used to confirm your HSV 2 infection.

The thing about your mouth sore is that yes, sometimes HSV 2 can be in the mouth and yes, sometimes herpes can cause sores on the hard palate, but so can HSV 1. So I don’t think knowing whether the sore was herpes or not is going to help us here. I also know that you want to know if your HSV 2 is only oral. The only way to confirm that is through a swab test should it come up again.

I think if you want to confirm the HSV 2 result the western blot would be the way to go. And yes, I have had people with ELISA scores about 4.5 not confirm with western blot, but these are few and far between and the history of both people did NOT fit with having a risk for HSV 2 infection, which is why I ordered the confirmatory test. I’m absolutely fine ordering western blots for anyone who would like that extra information to live more accurately with or without herpes. I must tell you that the chances this will not confirm are statistically slim

And yes, particularly if using culture, the earlier the swab is taken, the better.

Terri

[B-moreFriend]

Thank you Terri!

I think I am able to ask one more question? If not, please let me know.

I’m assuming I do have Genital H2. What I’m hoping is that the sore in my mouth is Not H2. I know it’s rare, but some people do have it and right now the information I do have makes me think the sore in my mouth is H2. Is the swab culture at all able to tell which herpes is present?

What is the best way to tell if an intra-oral sore is H2 vs H1?

Thank you

• This reply was modified 7 years, 12 months ago by B-moreFriend.

[Terri Warren]

I don’t know why you’ve decided to assume that the sore in your mouth is HSV-2 infection vs. HSV-1 infection but it seems that you have. You should know that in our research studies we have found that in people who are HSV-2 antibody positive with an index value that’s greater than 3.5, over 95% will shed virus from the genital tract, as detected by PCR, within about four months of beginning to do swabbing. So if you have HSV-2 orally, then if you were my patient I would ask you to assume that you also have HSV 2 genitally also.

You ask if the swab test can determine if a sore in your mouth is a type one or two. Yes, it certainly can and the best way to know if the sore is type one or two is to ask for PCR with typing when the swab test is ordered. That is a very simple request to make of the lab and should be no problem at all.

Were you able to obtain PCR swabs to have on hand should you have another outbreak in your mouth? Do you feel that you will pursue a herpes Western blot test in the future to confirm your agency to status?

This is the last question remaining on your subscription if you have more questions please do not hesitate to renew your subscription

I hope this has been helpful for you

Terri

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